<!--professional details strats-->
<div class="professional_details">
<!--scroll container starts-->   
    <div id="description2">
        <!--form starts-->
             <?php echo form_open(base_url().BASE.'join_as_submit_detail_continue', array('id' => 'join_as_form_institution_detail3', 'autocomplete' => 'off')); ?>   
             <div class="add">
         </div> 
              <div class="form_fields">
                <div class="textfield_box">
                     <input type="email" onBlur="this.value=jQuery.trim(this.value)" name="email"  value="<?php if(isset($input_data['email']))echo strip_tags($input_data['email']); ?>" placeholder="Email" id="email" class="detailed_textfield2 content_pink"> 
                     </div>
                     
                     <div class="textfield_box">
                     <input type="password" onBlur="this.value=jQuery.trim(this.value)" id="password" value="<?php //if(isset($input_data['password']))echo $input_data['password']; ?>" name="password" placeholder="Password" class="detailed_textfield2 content_blue">
                     </div>
                     
                      <!--<div class="textfield_box">
                    <input type="password" id="reconfirming_password" value="" name="reconfirming_password" placeholder="Reconfirming password" class="detailed_textfield4 content_blue">
                     </div>-->
                     <div class="textfield_box">
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name="first_name"  value="<?php if(isset($input_data['first_name']))echo strip_tags($input_data['first_name']); ?>" placeholder="First name" id="first_name" class="detailed_textfield4 content_pink"> 
                     <input type="text" onBlur="this.value=jQuery.trim(this.value)" id="last_name" value="<?php if(isset($input_data['last_name']))echo strip_tags($input_data['last_name']); ?>" name="last_name" placeholder="Last name" class="detailed_textfield4 content_blue">
                    </div>
                    <div class="clear"></div>
                    <div class="textfield_box">
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name="Shortname" id="Shortname" value="<?php if(isset($input_data['Shortname']))echo strip_tags($input_data['Shortname']); ?>" placeholder="Shortname" class="detailed_textfield2 content_blue">
                    </div>
                    <div class="clear"></div>
                    <div class="textfield_box">
                        <textarea name="tagline" onBlur="this.value=jQuery.trim(this.value)" placeholder="Tagline" class="content_blue detailed_textfield2"><?php if(isset($input_data['tagline']))echo strip_tags($input_data['tagline']); ?></textarea>
                    </div>
                    
                    <div class="clear"></div>
                    
                    <div class="textfield_box">
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name="Date_of_Incorporation" id="Date of Incorporation" value="<?php if(isset($input_data['Date_of_Incorporation']))echo strip_tags($input_data['Date_of_Incorporation']); ?>" placeholder="Date of Incorporation" class="detailed_textfield2 content_blue">
                    </div>
                    <div class="textfield_box">
                        <div class="country_form country2_form detailed_textfield content_pink"><?php if(isset($input_data['country']) && $input_data['country']!='')echo strip_tags($input_data['country_1']);else echo 'Country'; ?></div>
                    </div>
                    
                    <div class="clear"></div>
                     
                    <div class="textfield_box">
                        <div class="state_form state2_form detailed_textfield content_pink"><?php if(isset($input_data['state']) && $input_data['state']!='')echo strip_tags($input_data['state_1']);else echo 'State'; ?></div>
                            <div class="city_form city2_form detailed_textfield content_blue">  <?php if(isset($input_data['city']) && $input_data['city']!='')echo strip_tags($input_data['city_1']);else echo 'City'; ?></div>
                        <!--<input type="text" name="city" id="city" value="" readonly placeholder="City" class="detailed_textfield content_pink">
                        <input type="text" name="state" id="state" value="" readonly placeholder="State" class="detailed_textfield content_blue">-->
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name="postal_code" id="postal_code" value="<?php if(isset($input_data['postal_code']))echo strip_tags($input_data['postal_code']); ?>" placeholder="Postal Code" class="detailed_textfield content_pink">
                        <div class="clear"></div>
                    </div>
                    <div class="clear"></div>
                    
                    <div class="textfield_box">
                        <textarea name="Address" onBlur="this.value=jQuery.trim(this.value)" id="Address" placeholder="Address" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Address']))echo strip_tags($input_data['Address']); ?></textarea>
                    </div>
                    <div class="clear"></div>
                    
                    <div class="textfield_box">
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name="phone_number1" id="phone_number1" value="<?php if(isset($input_data['phone_number1']))echo strip_tags($input_data['phone_number1']); ?>" placeholder="Phone Number 1" class="detailed_textfield2 content_blue">
                    </div>
                    <div class="clear"></div>
                    <div class="textfield_box">
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name="phone_number2" id="phone_number2" value="<?php if(isset($input_data['phone_number2']))echo strip_tags($input_data['phone_number2']); ?>" placeholder="Phone Number 2" class="detailed_textfield2 content_blue">
                    </div>
                    <div class="clear"></div>
                    <div class="textfield_box">
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name="phone_number3" id="phone_number3" value="<?php if(isset($input_data['phone_number3']))echo strip_tags($input_data['phone_number3']); ?>" placeholder="Phone Number 3" class="detailed_textfield2 content_blue">
                    </div>
                    <div class="clear"></div>
                   
                   <div class="textfield_box">
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name="Branches" id="Branches" value="<?php if(isset($input_data['Branches']))echo strip_tags($input_data['Branches']); ?>" placeholder="Branches " class="detailed_textfield2 content_blue">
                    </div>
                    <div class="clear"></div>
                   
                    <div class="textfield_box">
                        <textarea name="About_Us" onBlur="this.value=jQuery.trim(this.value)" id="About Us" placeholder="About Us" class="detailed_textfield2 content_pink"><?php if(isset($input_data['About_Us']))echo strip_tags($input_data['About_Us']); ?></textarea>
                    </div>
                    <div class="clear"></div>
                    
                    <div class="textfield_box">
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name=" Business_Head" id=" Business Head" value="<?php if(isset($input_data['Business_Head']))echo strip_tags($input_data['Business_Head']); ?>" placeholder="Business Head" class="detailed_textfield2 content_blue">
                    </div>
                    <div class="clear"></div>
                    
                     <div class="textfield_box">
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name="Management_Team1" id="Management Team" value="<?php if(isset($input_data['Management_Team1']))echo strip_tags($input_data['Management_Team1']); ?>" placeholder="Management Team" class="detailed_textfield2 content_blue">
                    </div>
                    <div class="clear"></div>
                    
                     <div class="textfield_box">
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name="Management_Team2" id="Management Team" value="<?php if(isset($input_data['Management_Team2']))echo strip_tags($input_data['Management_Team2']); ?>" placeholder="Management Team" class="detailed_textfield2 content_blue">
                    </div>
                    <div class="clear"></div>
                    
                     <div class="textfield_box">
                        <input type="text" onBlur="this.value=jQuery.trim(this.value)" name="Management_Team3" id="Management Team" value="<?php if(isset($input_data['Management_Team3']))echo strip_tags($input_data['Management_Team3']); ?>" placeholder="Management Team" class="detailed_textfield2 content_blue">
                    </div>
                    <div class="clear"></div>
                    
                     <div class="textfield_box">
                        <textarea name="Products_offered" onBlur="this.value=jQuery.trim(this.value)" id="Products offered" placeholder="Products offered" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Products_offered']))echo strip_tags($input_data['Products_offered']); ?></textarea>
                    </div>
                    <div class="clear"></div>
                    
                     <div class="textfield_box">
                        <textarea name="Services_Offered" onBlur="this.value=jQuery.trim(this.value)" id="Services Offered" placeholder="Services Offered" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Services_Offered']))echo strip_tags($input_data['Services_Offered']); ?></textarea>
                    </div>
                    <div class="clear"></div>
                    
                    <div class="textfield_box">
                        <textarea name="Recommendations" onBlur="this.value=jQuery.trim(this.value)" id="Recommendations" placeholder="Recommendations" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Recommendations']))echo strip_tags($input_data['Recommendations']); ?></textarea>
                    </div>
                    <div class="clear"></div>
                    
                     <div class="textfield_box">
                        <textarea name="Associations" onBlur="this.value=jQuery.trim(this.value)" id="Associations" placeholder="Associations" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Associations']))echo strip_tags($input_data['Associations']); ?></textarea>
                    </div>
                    <div class="clear"></div>
                    
                     <div class="textfield_box">
                        <textarea name="Achievements" onBlur="this.value=jQuery.trim(this.value)" id="Achievements" placeholder="Achievements" class="detailed_textfield2 content_pink"><?php if(isset($input_data['Achievements']))echo strip_tags($input_data['Achievements']); ?></textarea>
                    </div>
                    <div class="clear"></div>
                    
                    
                    
                    <div class="submit_button">
                        <input type="button" value="" name="personal_detail" id="personal_detail3">
                    </div>
            </div>
            <!--select school starts-->
                    <div class="select_stateform select_state2form content_pink">
                            <div class="go_back">
                                <a href="javascript:void(0);" title="<?php echo $static_info['go_back'] ?>"> </a>
                            </div>
                            <input type="text" onBlur="this.value=jQuery.trim(this.value)" id="state2" maxlength="100" name="state" placeholder="State" value="<?php if(isset($input_data['state']))echo strip_tags($input_data['state']); ?>" class="textfield content_pink" data-autosize-input='{"space":10}' autocomplete="off">
                            <?php echo $static_text['we_are_located']; ?>
                            <input type="hidden" id="state2_1" name="state_1" value="<?php if(isset($input_data['state_1']))echo strip_tags($input_data['state_1']); ?>">
                            <div class="result_not_found" style="display:none;"><a href="javascript:void(0);">
                                <img src="<?php echo SKIN_URL_IMAGE;?>/submit.png"></a>
                            </div>
                            <br>
                            <div id="state2_result">
                            </div>
	                  </div>
            <!--slelect shool closed-->
            
             <!--select school starts-->
                    <div class="select_countryform select_country2form content_pink">
                            <div class="go_back">
                                <a href="javascript:void(0);" title="<?php echo $static_info['go_back'] ?>"> </a>
                            </div>
                            <input type="text" id="country2" maxlength="100" name="country" placeholder="Country" value="<?php if(isset($input_data['country']))echo strip_tags($input_data['country']); ?>" class="textfield content_pink" data-autosize-input='{"space":10}' autocomplete="off">
                            <?php echo $static_text['we_are_located']; ?>
                            <input type="hidden" id="country2_1" name="country_1" value="<?php if(isset($input_data['country_1']))echo strip_tags($input_data['country_1']); ?>">
                            <div class="result_not_found" style="display:none;"><a href="javascript:void(0);">
                                <img src="<?php echo SKIN_URL_IMAGE;?>/submit.png"></a>
                            </div>
                            <br>
                            <div id="country2_result">
                            </div>
	                  </div>
                <!--slelect shool closed-->    
                
                <!--select class starts-->
                    <div class="select_cityform select_city2form content_blue">
                            <div class="go_back">
                            <a href="javascript:void(0);" title="<?php echo $static_info['go_back'] ?>"> </a>
                            </div>
                            <input type="text" id="city2" maxlength="100" name="city" placeholder="City" value="<?php if(isset($input_data['city']))echo $input_data['city']; ?>" class="textfield content_blue" data-autosize-input='{"space":10}' autocomplete="off">
                            <?php echo $static_text['we_are_located']; ?>
                            <input type="hidden" id="city2_1" name="city_1" value="<?php if(isset($input_data['city_1']))echo $input_data['city_1']; ?>">
                            <div class="result_not_found" style="display:none;"><a href="javascript:void(0);">
                                <img src="<?php echo SKIN_URL_IMAGE;?>/submit.png"></a>
                            </div>
                            <br>
                            <div id="city2_result">
                            </div>
						</div>
                <!--slelect class closed-->
         				 <input type="hidden" name="member_type" id="member_type" value="<?php if(isset($member_type)){ echo $member_type;} ?>"  />
                         <input type="hidden" name="institution_type" id="institution_type" value="bussiness_entity"  />
                          
                <!--slelect class closed-->
              <?php echo form_close(); ?>     
        <!--form closed-->
    </div>
</div></div>
<!--scroll container starts-->
<!--information_inner closed-->